running

Static vs dynamic stretching. What’s the difference and what should I be doing?

by
When it comes to preparing your body for a workout, the notion of static stretching as a warm-up is facing a considerable challenge. Recent research is uncovering potential drawbacks, revealing that this traditional approach might not be the performance booster we once believed it to be. In fact, static stretching could have the counterintuitive effect of decreasing muscle power for hours post-stretch, potentially hindering your athletic performance.

The promise of injury prevention often associated with static stretching seems to fall short in the scientific realm. Studies are urging fitness enthusiasts to pivot toward dynamic exercises for a more effective warm-up routine. Dynamic exercises, such as proprioceptive training, strength workouts, and dynamic warm-ups, are emerging as champions in preserving performance levels and reducing the risk of injuries.

The shift from static to dynamic warm-ups has a growing evidence base. Dynamic exercises engage your muscles in a way that static stretching simply doesn’t. They prepare your body for the dynamic movements that lie ahead in your workout, enhancing flexibility, blood flow, and overall performance. As we bid adieu to the old-school static stretches, consider embracing a new era of warm-up routines that incorporate dynamic, agility, strength, and balance exercises for superior results.

So, before you settle into that long-held stretch pre-workout, take a moment to reassess. Your body might just thank you for the switch, unlocking a new realm of athletic potential and injury prevention. After all, in the dynamic world of fitness, adaptability is key. ????????

Running resolution

by

Physio for runners newcastle

Do you have a 2020 running resolution?

Here at NUmoves we love to support people to get active, exercise and stay healthy. If your 2020 goal is to get started on a running routine, we have a few simple tips to make it easy to keep on track and injury free!

  1. Setup for success – If you have not run for a long time, you will need to use an interval training (run-walk-run-walk) program condition your leg muscles before you can do longer runs. It is better to run at your natural pace and then walk for a short rest than to try and run very slowly. Here is an example of an interval program that should be tailored to your previous running experience and amount of time off.
Interval Program – Novice Runners (not first timers) – For return to run after 3-12 month break.
Weeks Time Run Walk 1st Week 2nd Week
1-2 15 mins 60secs 60secs 2 runs 3 runs
2-3 20 mins 120secs 60secs 2 runs 3 runs
4-6 25mins 120secs 60secs 2 runs 3 runs
7-8 25 mins 5mins 60secs 2 runs 3 runs
  1. Cross train – you can improve your cardiovascular fitness with other forms of exercise, cycling, rowing, swimming and HIIT classes are all great options if the running legs are feeling a bit overdone. A running specific strengthening program can work wonders to improve your running performance and reduce the risk of injury, which leads to the next tip…
  1. Listen to your body – most people will know when they are doing too much too soon, muscles feeling fatigued, tight, sore etc. Ignore the signs at your peril.
  1. Remember your goals! – Rome wasn’t built in a day. For long term success, take your time to get there and you will be much more likely to smash your running goals.
  1. Make it fun – listen to music, run your local trails, run with friends, take the dog, every time you complete a run give yourself a pat on the back, you are one step closer to being your best self.

Stress Fractures In Football

by

Football Physio Newcastle

Stress Fractures In Football

As we move towards selection for next year’s club football sides there is a tendency for players to push harder to prove themselves. More training, higher intensity, less rest / recovery time plus there can be school soccer games added in there, not to mention lunchtime playground fun. One consequence of an imbalance in load versus rest time is stress fractures. The earlier the problem is diagnosed the better the outcome and given that stress fractures can unfortunately lead to prolonged periods of lost game time, it is an important topic in football health and wellbeing. We have previously published a blog regarding stress fractures in runners, which includes a detailed explanation of the cause, biological process, diagnosis and management which you can read about here.

This blog will focus on some common causative factors and the division of the “high risk” versus “low risk” types of stress fractures, as these are managed very differently. The risk relates to the specific location within a given bone rather than the likelihood of developing that type of stress fracture.

Stress fractures almost always occur in one of the following scenarios, or a combination of these.

  1. Increase in load on a region of the body in a given (often too short) time period
  2. Decrease in recovery time relative to loading time
  3. Decrease in the bone’s ability to repair / remodel following exposure to load.

Therefore, when volume of load increases the risk is higher, such as progressing to a higher competitive level of play, a busy period in the season with extra games and training sessions, an increase in training load such as during pre-season fitness training or even a change in training surface or footwear relative to the amount of loading. Conversely if the athlete’s load remains unchanged but they have a change in diet, energy input, illness or nutritional balance this can lead to an increased risk of injury.

High risk stress fractures generally involve a bony area where there is critical blood supply or an ossification centre (where the bone grows from). An example of these are the Femoral neck (hip), Navicular bone (midfoot), base of the 5th metatarsal (outside of foot) and the medial malleolus (inside of the ankle). These are considered high risk due to the possibility of a full fracture disrupting the only blood supply to this part of the bone, which can lead to ongoing problems. The high risk stress fractures are often managed initially with complete unloading / non-weight bearing and then closely monitored during the periods of activity reduction / relative rest including repeated imaging studies to track bony healing. In more severe cases these can require surgical management. High risk stress fractures often require orthopaedic specialist involvement in early management. Regardless of severity if a stress fracture is diagnosed we recommend assessment and advice regarding management with a sports physician specialist.

Low risk stress fractures are located in areas with good blood supply which are known to heal well with relative rest and progressive rehabilitation. These are more common in soccer and mostly found in the postero-medial tibia (lower inside of the shin) and in the metatarsals (the forefoot). This type of stress fracture can usually be diagnosed clinically but usually require imaging (MRI / Xray) to confirm type and severity.

Effective management of these injuries in soccer players requires good communication between the physiotherapist, sports physician, coaches and player, especially given the potentially longer period of recovery than most soft tissue injuries. It is important not to continue to play if a stress fracture is a possibility.

If you have any questions on the information in this blog or need assistance in diagnosis or rehab relating to soccer injuries, contact us on admin@numovesphysiotherapy.com.au or 49216879.

ACL Reconstruction – When is best?

by

ACL reconstruction

The NU Moves team recently did a masterclass session into the research associated with ACL tears and reconstructions. The questions we raised were based on a randomised trial published in BMJ in 2013 and several papers this year from Assoc Prof Richard Frobell and collaborates*.

Do you always need to have an ACL reconstruction?

Surgical repair of the ACL depends on the presence of instability and your specific goals. If you want to play sport involving change of direction (football, netball, basketball, etc) then surgery is recommended. However, having surgery in all cases is not as clear as it was 10 years ago. If you only want to walk and cycle then in some cases it’s possible to rehab the knee to an adequate level of stability. Persistent feelings of instability or giving way after rehab would warrant consideration of surgical intervention in any case, even if you don’t want to play sport.

When is the best time to have an ACL reconstruction post injury?

Current evidence clearly shows better outcomes are achieved if the patient undergoes an initial period of rehab prior to surgical intervention, deciding when and whether to have ACL surgery can be made once you have completed your rehab. A 12-week rehab period should be used to reduce swelling and regain strength and stability.

What should you do before ACL reconstructive surgery?

You must have a physiotherapy assessment and intervention. When we refer to rehabilitation following an ACL injury it involves strategies directed at reducing pain and swelling from the initial injury; regaining mobility and muscle length; and mostly importantly strengthening all the muscles of the legs to provide stability at the knee. These factors are the most relevant factors influencing your functional outcome, should you undergo ACL reconstruction.

Do you need to have an MRI?

Yes. If you have a suspected ACL tear then you should have an MRI to investigate, your doctor or physiotherapist can arrange this. The extent of ACL injury and other cartilage damage that can occur with ACL injuries are best identified via MRI. If there is significant meniscal or other cartilage damage then it needs to be considered relative to the rehab management and sometimes earlier surgery.

Do you always need to see an orthopaedic specialist?

Yes. They are the specialists of ACL surgery. Alternatively you could see a sports physician for a non-surgical opinion. There is now debate around the prevention of arthritic changes in the knee by undergoing ACL reconstruction surgery, evidence of its effectiveness is still valid but not as clear cut as it was 10 years ago. Studies over longer periods of time are still required to fully answer the question of whether surgery is better than conservative rehabilitation to delay or avoid arthritic change in the ACL injured knee. Getting a good orthopaedic opinion relative to your injury and goals is advised. For isolated ACL injuries it is now clear that better outcomes are achieved after a 3 month pre operative rehab period. So get the rehab started and then organise an orthopaedic referral at a time that suits you.

If you have any questions or have injured your ACL contact us to organise a time to start your rehab. Read more about knee rehab here.

* Articles reviewed:

  1. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. Frobell et al. BMJ Jan 2013.
  2. Lower extremity performance following ACL rehabilitation in the KANON trial. Ericsson et al. Br J Sp Med 2013.
  3. Delaying ACL reconstruction and treating with exercise therapy alone may alter prognostic factors for 5 year outcome. Filbay et al. Br J Sp Med 2017.
  4. Surgical reconstruction of ruptured ACL prolongs trauma induced increase of inflammatory cytokines in synovial fluid. Larsson et al. Osteoarthritis and cartilage 2017

Common biomechanical problems with runners – flexibility

by

Stretching running physiotherapy

Last week’s blog looked at strength in key muscle groups for runners. This blog is highlighting areas of the body where flexibility is useful at preventing pain associated with running. There has been a lot of research on muscle length / flexibility relative to preventing injuries and the summary is commonly that it doesn’t help. However sometimes the research doesn’t give us the full picture on how to help an individual with pain and that is where having an experienced physio counts. Helping runners return to exercise after pain or injury results in a wealth of experience based knowledge. In relation to muscle length it is that if you don’t have the mobility in the correct places it can lead to injury. An obvious example is a hurdler who tightens up in the hamstring and lacks the flexibility to get the front leg over the bar.  The key area for everyday runners to maintain flexibility is in the front of the hip.

The front of the hip / hip flexors includes 3 muscles, one of which is the TFL (tensor fascia lata) that connects to the ITB (iliotibial band). One example of a common runner’s problem is not having enough hip flexor length which can impair the buttock (gluteal) muscle function and lead to the TFL muscle working harder to stabilise the pelvis whilst running. This can then lead to ITB tightness and pain in runners. Another example is tightness in the hip flexors leading to an increased arch in your back. When this combines with the glut’s switching off hip or back pain are common.

hip flexor tightness and low back pain
Tight hip flexors

Correctly stretching your hip flexors should be comfortable. It is possible to make short lasting improvements in muscle length so if you are tight you need to stretch before you run (despite some research assumptions!). Don’t forget to control the pelvis when stretching.

hip flexor stretch
hip flexor stretch – pelvic tilt / roll

The best plan is if you have pain then get one of the experienced NU Moves physio’s to assess and determine if that’s what you need to get you back to running pain free.

Running biomechanics and muscle strength

by

Running physiotherapy injury

 

Biomechanics refers to how we are built and how we move. Some of us have legs that bow out (varus alignment) and others have knock knees (valgus alignment) which relates to the shape of our bone structure. It is a combination of our bony structure and how well our muscles work that can increase the likelihood of injury with running. This blog is looking at key areas of muscle weakness that alter our biomechanics and lead to injury. Your bony structure can’t be changed but improving your strength in the right areas can be achieved within 6 weeks of an exercise program that is designed for you. Assessing the biomechanics of the body combined with a basic understanding of your running style is important if you are serious about running.

A biomechanical physiotherapy assessment considers whether you have sufficient strength and mobility in the right places for running. The muscles in the back of the leg (calf, hamstring and gluteal) are important to maintain strength for running. Weakness in these muscles often leads to pain and injury in runners.

  • Calf muscle and Achilles tendon strength – it is important to understand that both muscles and tendons can respond to the loads we put on them. A simple test and exercise for the calf and achilles is the calf raise. If you can’t do a repeated full height single leg calf raise of more than 6 reps than you probably don’t have enough strength. I encourage people to get to 15 reps and be able to repeat 3 sets as a baseline but there isn’t a magic number here because it also depends on your running style. If you are about to change your style and get further forwards on the forefoot then check your calf and achilles strength first to minimise the chance of getting achilles tendon problems.

calf raise

  • Hamstring strength is essential for fast running but a base level of strength is also important for your park runners to 10km distances. Clearly the most functional way to strengthen the hamstrings for running is to gradually increase the distance and intensity of your running sessions. If you can’t do a hamstring bridge exercise or it takes considerable effort then you need to get stronger. Caution with doing this exercise – if it causes back pain then stop and discuss with one of our physio’s.

hamstring bridge

  • Gluteal (buttock muscle) strength allows for a stable pelvis during running. If you don’t have adequate gluteal strength it puts extra load on the knees, hips and lower back. Unless you have had a biomechanical physio assessment you probably don’t know if your glut’s are working well enough. A glute bridge is similar to a hamstring bridge but the knees are bent at approximately 90°. By bending the knees it makes it harder to use the hamstrings to lift the bottom and thus challenges the gluteal muscles more. Again if you have back pain stop and get some advice.

glute bridge

  • A squat is another good exercise to get the glute muscles working for runners but it needs to be done correctly. Keeping the back straight and bending at both the knees and hips gets the gluteal muscles working. Once you have been taught to do a squat correctly the challenge is a single leg squat with letting the knee drop in valgus collapse.

Squat exercise

Hope you have enjoyed reading about good strength exercises for runners. Thanks to Pete for his stick figure art which has been enjoyed by his clients for many years.

 

Running injuries – How to avoid them

by

running

There is a lot of expert opinion on running technique for performance and injury but its complex and sometimes contradictory. When we look at running without injury what helps one person often doesn’t for the next. Pain is not uncommon with running so for this article lets define an injury as when pain influences your running. This article is running advice that often does help get you running pain free …

Planning your approach to running is important but most of us just run when we get the time.

How often should I run is a great question with many possible answers. Let’s start with why you run? Having a goal is an important part of getting started. What do you want to achieve by running: increase fitness, lose weight, do a 5km park run, improve your time for running a set distance, complete a half or full marathon or simply feel better mentally and physically. Let’s aim to minimise or avoid muscle or joint pain that stops you from continuing to run.

How often (runs per week) and how long (distance)?

This depends on whether you have been running lately or not. If you haven’t run in the past 12 months then you need to start slower and less frequently then increase more gradually. There are apps such as couch to 5kms that can help guide you with graded increases. If you already have a base level of running fitness then you can progress more quickly.

Starting with 2 runs per week and working up to 4 per week is a good guide for frequency but it depends on how far you are running and you base running fitness. Starting with 3km walk / jog progressing to continuous jogging then working towards 5km (park run distance) is a good place for those who haven’t run recently.

One of the most common mistakes leading to joint or tendon pain is just doing too much too soon.

If you have had running injuries such as back or hip pain, shin splints or knee pain previously then a physio assessment is recommended before you start. This will identify stretches and strength exercises that will help and provide a guide to how often and how far you run when getting started.

What surface (grass, beach, cement, road)?

The surface you run on needs to be considered. If you want to do a half marathon on road and cement then we need to prepare your body for these surfaces. But if you are just getting started grass has the least impact and has most give to reduce impact stress through the legs. Road or tar is next then cement is the most stressful. Beach is obviously going to have less impact but be careful on the wet sand near the water if there is a reasonable side slope as this will quickly lead to pain. Soft sand level running is hard work, fantastic fitness and low impact but again don’t go too hard too soon. If you are prone to foot pain, then you should have shoes on even for beach runs.

What type of shoes?

There is a lot of research being done around shoe types and orthotics. You can read more detail in our running shoes blog but the only accurate advice is once you have found a type of shoe that allows you to run without pain then stay with it. Finding that shoe becomes more difficult and it is recommended that a physio assessment look at your foot type, muscle strength and running style to best advise a starting point.

How should I run (technique)?

There is lots of information about the ideal running technique (such as the ‘pose’ method) but what suits one body may not suit the next. To land on your heel first like when we walk is associated with increased pressure on the joints in our legs. Alternately to land on the forefoot increases loads on the achilles, calf and shin. If someone has a natural preference to one style and doesn’t have any complaints then you are best not to change your style. If you are trying to avoid knee pain by running more on your forefoot you might just develop an achilles problem and then not be able to run. If you do have joint pain and have been advised to change your running style then get advice and make the change very slowly.

If you have any questions in relation to preventing or treating running injuries let us know on admin@numovesphysiotherapy.com.au

 

ITB and knee pain in runners

by

Running

Our NU Moves Physio team recently debated the current beliefs surround the ITB and how it can give you lateral (or outside) knee pain which is also referred to as ITB syndrome. Here is a simple take home message from a complex discussion.

* The diagnosis of ITB syndrome can be made clinically without investigations

* The lateral meniscal cartilage of the knee needs to be considered as a possible source of pain which may require MRI imaging. A clinical assessment will predict if this is likely.

* The most common cause of the problem is an increase in the amount of running or ‘load’ on the knee. Treatment of acute ITB syndrome must include initially managing the load to help reduce inflammation.  This is usually via modifying the running program.

* The hip is the key to controlling this problem. Most importantly the strength and timing of the gluteal (buttock) muscles need to be sufficient to hold your pelvis and leg stable enough during running. Secondarily having enough flexibility in the hip flexor muscles often helps get the gluteal muscles functioning better.

* Rolling the ITB is a common form of treatment utilised if tightness is perceived as part of the problem. If rolling gives you relief of pain associated with running or any other exercise then we cannot argue with that however understanding the reason behind why it may or may not help is the challenging part. Roll it if it helps you but make sure you start your rehab at the hip.

Prescribing running shoes – A guide through the fog of misinformation

by

Running shoes are often prescribed based on arch height, degree of pronation they show when running and the latest trends like maximum cushioning and minimalist shoes. So how do you know what advice to follow and which shoes are right for you?

1. Arch Height
It is common practice to prescribe footwear based on the height of your foot arch, such as motion control shoes for people with flat feet and a cushioned shoe for people with high or stiff arches. This has previously been common practice but does not appear to affect the likelihood of sustaining an injury while running.

2. Pronation
Although over-pronation (too much rolling in) of the foot while running is often blamed for many running injuries, there is conflicting evidence to support this. It is unclear what a normal amount of pronation is and the difference between the movement of the shoe and the movement of the foot can be up to 20% while running, which makes measuring the amount of pronation difficult even with video analysis. If you cannot accurately measure pronation then fitting a shoe based on foot type becomes trial and error.

3. Trends
Over the years many trends regarding footwear have come and gone such as minimalist, anti-pronation and extreme cushioning shoes. It is important to consider that even people with the same foot type will respond differently to the same shoe. Therefore it is clear that one type of shoe will not suit everyone and buying shoes based on the latest trends can be erroneous.

So how should you choose what shoes to wear when you run?
1. Experienced Runners
Draw from experience, know what works for you and stick with it. Don’t be tempted by the latest trends and marketing, but if you are, incorporate the new shoe slowly and as an occasional change of pace.

2. New Runners
The most important thing to consider for a new runner is comfort. Try a few pairs on in the store and see how they feel. Initially staying away from extremes such as anti-pronation or extra cushioning shoes is a good place to start.

3. Runner with recurring injuries despite a change in shoes
Remember that shoes play a small role in sustaining most injuries and it is important to consider body mechanics, movement patterns and training habits when attempting to reduce injury risk.

If you are having recurring injuries while running, have a physio assessment to work out what is the best way to get you running pain free.

This blog is a summary of a great educational video from Kevin at Running reform http://www.runningreform.com/

Watch the original video at https://vimeo.com/126720173